Suicide: America’s Grim Bellwether, Part 1

by Jeanene Harlick | May 27, 2016 6:36 am

Following is Part 1 of my chapter on the socio-politics of suicide for the forthcoming, 3rd edition of “Community Mental Health: Challenges for the 21st Century,” edited by Jessica & Samuel Rosenberg. If you are interested in reading the rest of the chapter, please consider purchasing the book (I receive no money from book sales); you can also sign up to receive an email when additional articles are posted on this Web site, using the form at the bottom of this page. Please consider donating below; unless “A Disordered World” receives donations, this will likely be the last article posted due to lack of income. 

 

“Suicide is revealing: it exposes deep divides between the top and bottom of the social scale in terms of health, life expectancy and well-being. Suicide forces us to take these deep divides into consideration… All the data gathered by psychiatrists and epidemiologists tends to relate suicide to depressive states and alcoholism… [But] what is at stake is the meaning of life and even the status of the subject….”

-Christian Baudelot & Roger Establet, “Suicide: The Hidden Side of Modernity” (2008)

Introduction

In Charlotte Brontë’s novel Villette, main character Lucy Snowe, as a young schoolteacher, endures a period of “overstretched nerves,” feelings of “cruel desolation,” utter loneliness and hopelessness which cause her to exhibit behavior that would today result in the iron-branded, DSM diagnoses of anorexia and major depression:

“Alas! When I had full leisure to look on life as life must be looked on by such as me, I found it but a hopeless desert: tawny sands, with no green fields, no palm-tree, no well in view. The hopes which are dear to youth, which bear it up and lead it on, I knew not and dared not know. If they knocked at my heart sometimes, an inhospitable bar to admission must be inwardly drawn… A goad thrust me on, a fever forbade me rest; a want of companionship maintained in my soul the cravings of a most deadly famine.1” 

Snowe’s unbearably-weighty, “affliction on my mind” – brought on by a summer of unemployment, extreme isolation, “want of companionship” and a bleak future – causes Lucy to rise, in her weakened, emaciated state, from bed one stormy, October evening. She wanders off across distant fields in search of solace – or, if she can’t find it, death:

“That evening more firmly than ever fastened into my soul the conviction that Fate was of stone, and Hope a false idol – blind, bloodless, and of granite core… A sorrowful indifference to existence often pressed on me – a despairing resignation to reach betimes the end of all things earthly.2

Lucy goes to a certain quiet hill she knows of, discovers a church where she vents her pain to a kind priest; then departs and, though finally relieved, gets lost and collapses from malnourishment among foreign streets.

Luckily for Snowe – and Brontë’s readers – Lucy is found, and regains her mental and physical strength. Spared psychiatry’s taint, she goes on to fulfill a successful career as a teacher and, by book’s end, headmistress and proprietor of her own school– despite never marrying, despite being a single, working woman in Victorian times.

I sometimes wonder if I – like Snowe, a permanently single woman who has long battled “overstretched” nerves, a “tossed” mind, “despairing resignation,” hopelessness, and periods of restricted eating – had escaped psychiatry’s clutch, I might not be writing about suicide today. I wonder, if I hadn’t been lured into the traditional mental health system – and tainted with ensuing stigma – I wouldn’t have ended up unemployed at age 32 and on a decade-long path which eventually led, also on a recent October night, not to an isolated hill but my apartment rooftop, where I jumped to what I thought would be my longed-for death.

I woke up, intubated, in the ICU three days later unable to move, bones and joints broken in every part of my body, including my skull and jaw. I was in the hospital a month, undergoing a series of agonizing surgeries as doctors patched me back together with titanium plates, screws, rods and braces. I spent another month in a nursing home, where I did not spend my hours feeling grateful I was alive. I did not feel blessed with some divinely-bestowed gift which suggested I’d “survived for a reason” or think that, because I survived, my life suddenly had newfound purpose.

No, on the contrary, for many weeks and months – and even now, many a day – I felt just the opposite, as I’ve learned many suicide attempt survivors do3: that my sh—ty life had only become sh—tier, and I was now coated with an extra layer of stigma.

The problems which drove me to be one of the .5 percent of people who go from thinking about suicide, to actually doing it4, didn’t magically disappear simply because I survived; they have only grown larger. Those driving factors – which researchers are only beginning to understand – had little to do with my pre-existing “mental illness” (a label I have problems with) but a lot to do with the prejudice-laden society, times and political landscape I live in. And it’s that point that I will try to drive home in this chapter – not only because this new understanding of the true underpinnings of suicide is critical to improving counseling and reducing rates, but because I and millions of struggling individuals and attempt survivors are tired of having clinicians and the general public blame our “sick” minds or moral deviancy for wanting to take our lives, when it’s a sick society that’s the true culprit.

Suicide is the topic nobody wants to talk about – or, at least, talk frankly about on a level which rises above simplistic, prevention-oriented clichés or flat-out judgments. That’s because suicide is scary, morally fraught, emotional, complex, and forces people – when thoughtfully examined – to confront fundamental questions about existence, the line between sanity and insanity, religion, and society’s role in driving some humans to a point of such utter despair they’ll walk willingly into death’s hands. An almost impenetrable wall of taboo also shields the public from having to tackle an act which was not fully decriminalized until the late 1960s, and which long has been considered a transgression against God, society and family.

But there is a hidden hunger to talk about suicide. When I published an article which very frankly discussed my attempt, and the wider phenomenon, in December 2015 I was flooded with messages. People passionately thanked me for honestly writing about suicide in a way few others are willing. I realized there are millions of people out there desperate to discuss thoughts and feelings which society misinterprets and frowns upon, and so which are kept hidden – millions of people crying for redress, and relief.

As I delved deeper into both newspaper stories and the academic literature on suicide I discovered that at this point in modern times, more than ever, there is an urgent need to puncture the silence surrounding suicide, because its prevalence is escalating at alarmingly rapid rates both here and throughout the world. While deaths from homicides and most major diseases have decreased over the past 15 years, United States’ suicide rate has steadily increased, reaching its highest in 30 years in 2014 – 13 people per 100,000.5 More people die now from suicide than from car accidents, and it claims more than twice as many lives as homicide.6 A recent Newsweek article said our nation’s failure to curb its tenth-leading cause of death constituted an “epidemic”.7 In many other countries, including Japan and India, rates are even higher; the World Health Organization (WHO) is so concerned it released a special report in 2014 on the need to recognize suicide as a global public health issue and to improve prevention efforts.

The demographic group driving the trend in the U.S. are middle-aged adults, adding to a slew of recent studies indicating a new steady state of suffering, hardship and desperation among American breadwinners.8 Suicide rates for adults aged 35–64 years old are increasing faster than for any other age group, and the spike is sharpest for 45-64 year olds; since 1999, the rate for this group has increased 63 percent for women and 43 percent for men.9

During the exact same time period, middle-class incomes fell substantially in almost 90 percent of metro areas throughout the nation.10 Studies have shown a link between the recent rise in suicide and increased socio-economic distress.11

Analyses of Centers for Disease Control and Prevention (CDC) data show that suicides, along with substance abuse, are also responsible for an alarming spike in overall death rates for working class, white adults under age 65, off-setting the benefits from advances in medical treatment for conditions like heart disease.12

Suicide’s impact isn’t limited to the nearly 43,000 individuals who annually fall victim to it. An additional million individuals aged 18 and over attempt to take their lives yearly; 2.7 million Americans make a plan; and 10 million have suicidal thoughts13 – and those are conservative estimates, due to underreporting.

And then there’s the close family members – six per suicide decedent, on average – who have to contend with the unique, complicated form of mourning and emotional scars suicide leaves in its wake14: “The strong traumatic charge it carries ensures that the shock wave [suicide] generates will spread across an area that is quite disproportionate to its statistical rarity… It is a highly visible aspect of social life,” wrote Baudelot and Establet.15

To those who still prefer to turn a blind eye toward this growing problem – despite such alarming numbers – because they write suicide off as the act of the cowardly and crazy, perhaps the cost to society can sway them. In 2015 alone, suicide deaths cost the nation an estimated $51 billion in combined medical and work loss costs – that’s more than $1 million per casualty.16 Despite the human and public toll, however, research behemoths like the National Institute of Health and CDC continue to devote far greater sums of money to finding cures for diseases and social problems which kill far fewer Americans. In fiscal year 2015-2016 the CDC earmarked no money for suicide intervention, while spending $788.7 million on HIV/AIDS prevention and research17– even though the former kills more than the latter. The authors of a Journal of Clinical Psychology article surmised the cause of this gaping disparity is likely stigma.18

I spend a lot of time now wondering how I went from a shy but happy girl who devoured books and taped foil around my wrists, spinning until I’d turn into Wonder Woman, to the woman who turned instead into a ravaged, emaciated, hopeless, and self-loathing 41-year-old that jumped off a building this past year. Just 12 years prior I had been a thriving newspaper journalist who’d successfully steered clear of the mental health system that shamed and stigmatized me in high school. But in 2004, I decided to give that system another try when I entered a residential treatment program during a period of worsening struggle.

That decision marked the moment psychiatry swallowed me whole, and convinced me and all who knew me I was nothing but a walking bar code of DSM acronyms and pathology. I bounced from treatment program to treatment program for the next ten years; when I finally escaped the system in 2013, it was too late. My identity as “failed mental patient” was solidified, and I had glaring time gaps on my resume. I applied for hundreds of jobs; no one would hire me. I started a Web site, “A Disordered World”; it drew a small, enthusiastic audience, but no mainstream outlet would publish me and one even plagiarized me.

Living in poverty in 2015 – SSDI was, and is, my only income – evidence continued to amass that I’d never be granted entry back into mainstream life. My only viable next step, by the fall of 2015, was clear. It was time to take my life, once and for all. Death was preferable to the disgraced, economically insufferable, and solitary existence I was keeping.

Some people, including many mental health professionals, like to say suicide is a permanent solution to a temporary problem. But those of us living as members of disenfranchised, oppressed minority groups, and grappling with socio-economic hardship or psychological distress – or both – know better. Suicide is a permanent solution to a permanent problem. It is our only path to peace and dignity, an exit route from what we finally realize is a fundamentally unjust world. A world where the “American Dream” is a ruse and in which we are powerless agents futilely trying to re-charter our course, when the political ship captains would never deign to give us – the stokers shoveling coal in the boiling room – a second thought, much less a say in the ship’s path.

I believe – and the research I’ll summarize below should prove it – our suicide problem is the penultimate expression of growing multitudes of hopeless Americans; it’s citizens tired of working hard with no pay-off, while others earn millions posting selfies; it’s the voiceless speaking out in the only way now available to them; it’s driven by the same forces that made Bernie Sanders and Donald Trump, against all reason, serious 2017 presidential contenders.

The numbers back me up. A news analysis showed that death rates are highest in counties where Trump’s support was strongest.19 These are counties who’ve lost significant numbers of manufacturing jobs since 1999 and whose residents are less educated.20 It’s a tragic example of how the personal is political.

“These Americans know they’re being left behind by the economy and by the culture,” observed The New Yorker about our nation’s “epidemic of despair”.21

Robert Putnam, a professor of public policy who studies America’s new class divisions, warned about the rise in middle-aged suicide:

“This is part of the larger, emerging pattern of evidence of the links between poverty, hopelessness and health”.22

Reducing suicide to a problem of the mentally ill is one of the top myths about this inextricably complicated act, according to the aforementioned WHO report. “Although suicide can be the epilogue of many psychiatric disorders, the majority of people who kill themselves are not patients of [mental health] services,” said leading British suicidologists Stefan Priebe and Alfonso Ceccherini-Nelli.23 Outside of the United States, where psychiatrists are less tied to the medical model, you find scholars calling for an end to the “faulty connection”24 between suicide and mental illness; you find researchers who are scathing in their criticism of traditional psychiatry’s blind adherence to medicalizing suicide as the act of the mad25, particularly in light of a growing body of research linking it to economic distress.26

Inside the United States, sociological dimensions of suicide are receiving increased recognition – but you have to look to venues other than psychiatry, mainstream news coverage and political press releases to find it. Groundbreaking research being undertaken in the fields of epidemiology, cultural anthropology, public health and history is demonstrating suicide’s connection to classism, poverty, prejudice, and discrimination – which helps explain, for example, why the ethnic group with the highest suicide rate in the U.S. is American Indians.27

This chapter aims to examine the link between suicide and disadvantage more closely, and put to rest false assumptions about suicide and mental illness. It will also review the disproportionate amount of socio-economic distress and discrimination experienced by the psychiatrically disabled, to drive home my argument that it’s injustice that’s at play in the deaths of most decedents who do have histories of mental illness – not their “mental illness.” While I don’t deny there’s a small link between mental illness and taking one’s life, the evidence is overwhelming that having a mental disorder is only one of several risk factors.28

I want to demonstrate the above points to help raise the conversation about prevention to a level where truly effective policies are developed:

“A genuinely open discussion of suicide must be a wide discussion – not just a medical or public health discussion, but a social, cultural, moral, political and even religious discussion,” wrote medical ethicists Fitzpatrick and Kerridge, on the type of dialogue which must now occur.

Let me provide some information from China, as an end to this long introduction, to help drive home my point. China is the only country where women take their lives at higher rates than men.29 Suicide there is often an expression of protest or revenge against a party which has publicly shamed, abused or oppressed a person, because suicide causes Chinese perpetrators to “lose face”.30

While unfortunately in the U.S., suicide doesn’t cause anybody but its victims to “lose face,” I think it does collectively symbolize a sort of silent protest, as well as hopelessness, from a growing population of oppressed and disenfranchised, middle-aged adults. We live in a period of widely-recognized, heightened economic inequality where people at the bottom of the social ladder aren’t reaping the benefits of soaring national wealth. There is a strong correlation between low socio-economic status and suicide, as will be discussed later. We’re not going to reverse escalating suicide rates by pumping more money into treating depression; we have to attack what’s causing our national depression: social injustice.

As psychiatry professor John Werry said, “The thing that’s most likely to have an effect [on suicide] in the long run is social policies which aim to give children, adolescents, and their families a fair break in life.”31

I tried to kill myself because I knew I was never going to get that “fair break.” And I firmly believe that’s the same reason more than 43,000 Americans are dying yearly in what is an entirely avoidable tragedy – if the powerful of our country simply cared.

The author can be contacted at jeaneneharlick[at]gmail[dot]com. 

Additional sections in this chapter include:

Suicide = Mental illness: An insidiously harmful myth

Suicide taboo and the imperative to reverse it

Suicide and socio-economic status

Suicide, socio-economic status & the mentally ill: More disadvantaged, more oppressed

Conclusions and recommendations 

 

 

References

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3Didi Hirsch Mental Health Services (2013). Survivors of suicide attempt support group. Retrieved March 18, 2016, from http://www.didihirsch.org/survivors-of-suicide-attempt-support-group.
4Dokoupil, T. (2013, May 23). Why suicide has become an epidemic – and what we can do to help. Newsweek. Retrieved December 15, 2014, from http://www.newsweek.com/2013/05/22/why-suicide-has-become-epidemic-and-what-we-can-do-help-237434.html.
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